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Outcomes of Rapid Identification of Bacteremia in Combination with Antimicrobial Stewardship Intervention

Published online by Cambridge University Press:  02 November 2020

Marilia Bernardes
Affiliation:
Memorial Sloan Kettering Cancer Center
Julieth Formosa
Affiliation:
Mount Sinai Medical Center
Julia Bini Viotti
Affiliation:
Miller School of Medicine University of Miami
Anthony Febres-Aldana
Affiliation:
Mount Sinai Medical Center
Kenneth Ratzan
Affiliation:
Mount Sinai Medical Center
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Abstract

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Background: Rapid diagnostic tests designed to provide bacterial identification and detection of resistance genes directly from positive blood cultures can significantly reduce the time to definitive results, ensuring appropriate and timely antibiotic administration while simultaneously decreasing antibiotic overuse and development of antimicrobial resistance. However, their impact on in-hospital mortality and length of stay (LOS) is yet to be fully assessed. Methods: We retrospectively reviewed bacteremia cases in patients hospitalized over a 6-month period before (n = 78) and after (n = 93) the implementation of Verigene bacterial nanoparticle testing. Exclusion criteria included age >90 years, bacteremia thought to be a contaminant, polymicrobial bacteremia, or hospice admission. Verigene was performed at a central laboratory from 6 a.m. to 11 p.m. Pharmacists notified physicians of results and assisted with antibiotic modifications. Patient demographics, time to organism identification, time to effective antimicrobial therapy, and other key clinical parameters were compared. The primary outcomes were in-hospital LOS, 14-day mortality, and 30-day mortality. Secondary outcomes included time to effective antibiotic therapy and intensive care unit (ICU) LOS. Results: Organism identification was achieved more quickly (4.9 hours vs 44.5 hours; P < .001) and effective antibiotic therapy was started earlier after Verigene implementation. The mean in-hospital LOS decreased from 13.15 days to 10.02 days (P = .0071) after the Verigene intervention, despite a higher mean Charlson comorbidity index among the cases. Mortality was similar between groups. Conclusions: Rapid identification of gram-positive and gram-negative bacteremia with an antimicrobial stewardship intervention can decrease time to effective antibiotic therapy and total LOS.

Funding: None

Disclosures: None

Type
Poster Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.